Non-specific Thoracic Back Pain

• Non-specific Thoracic Back Pain:

  • Most common type of thoracic related back pain
  • Evidence is limited and based mostly of lumbar spine
  • Unlikely to be because of a serious problem such as cancer, infection, fracture, or as part of more widespread inflammation
  • no specific pathology can be given as an answer to the symptoms and no correlation with imaging
  • Nociceptive in origin
  • Range of sources; Intervertebral joint structures (IVD, Rib articulations, facet (zygapophyseal) joint), muscle and soft tissue.
• Non-specific Thoracic Back Pain - History & MOI:

  • Can largely be broken down into two main mechanisms
  • Gradual onset: Reports no specific incident, often reports a history of change in activity (amount, type, technique) or sustained postures (increased sitting, unaccustomed postures)
  • Acute sudden: reports a mechanism of injury post a specific movement usually that is unguarded, involving lifting or rotation
• Non-specific Thoracic Back Pain - subjective features:

  • Symptoms between or around the medial border of the scapulae, unilateral or bilateral
  • Rib involvement if symptoms 2 inches from midline +/- referral into rib
  • Mechanical in nature: Aggravated by activity or specific movements
• Non-specific Thoracic Back Pain - objective features:

  • Reduced ROM – particularly rotation and side flexion
  • Pain with breathing – may indicate rib involvement
  • Pain reproduction on accessory assessment
  • Posture and activity Assessment: Altered movement/loading related to aggravating and easing factors
• Non-specific Thoracic Back Pain - key impairments:

  • Loss of ROM : limited by pain and/or stiffness – articular, soft tissue, muscle
  • Loss of strength and endurance: Movement direction specific or activity related
• Non-specific Thoracic Back Pain - Management:

  • Advice & Education:
  • Explain what is wrong: self limiting, will improve with time
  • Address fears and unhelpful beliefs
  • In the acute phase: Relative rest, encouragement of early (safe) return to activity
  • Symptom Control:
  • Reduce load/movement into aggravating positions
  • Encourage active pain free mobility, particularly those that ease symptoms
  • Postural education: Encourage changes in posture and positions regularly
  • Manual Therapy may be indicated for short term pain relief – never in isolation
• Non-specific Thoracic Back Pain - Management:

  • Overall aims: Target impairments and activity limitations contributing to the presenting condition
• Non-specific Thoracic Back Pain - Management - Build Capacity:

  • Restore normal movement: Address limitations in ROM
  • Exercises to increase mobility – particularly thoracic rotation and side flexion
  • Manual therapy for short term benefit – never in isolation, in combination with active treatment
  • Restore deficits in strength
  • Exercises to improve muscle strength and endurance within the thoracic spine: thoracic rotation, extension
  • Exercises to improve muscle strength and endurance involved scapulothoracic function: Rhomboids, serratus anterior, Trapezius
• Non-specific Thoracic Back Pain - Management - Build Capacity:

  • Postural control and advice
  • relevant to those who present with gradual onset related to sustained activities and postures - help build capacity for those activities that aggravate their symptoms
• Non-specific Thoracic Back Pain - Management - Return to Function:

  • Advanced rehabilitation to build strength and conditioning in order for sufficient strength, mobility and control towards specific goal/function/sporting activity and prevent a recurring issue
  • Increase load and resistance particularly into previously identified impairments – ensure capacity is there
  • Graded return to activity
• LOOK AT THIS LECTURES CASE STUDY WHEN REVISING